Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

被引:833
作者
Pimentel-Nunes, Pedro [1 ]
Dinis-Ribeiro, Mario [1 ]
Ponchon, Thierry [2 ]
Repici, Alessandro [3 ]
Vieth, Michael [4 ]
De Ceglie, Antonella [5 ]
Amato, Arnaldo [6 ]
Berr, Frieder [7 ]
Bhandari, Pradeep [8 ]
Bialek, Andrzej [9 ]
Conio, Massimo [10 ]
Haringsma, Jelle [11 ]
Langner, Cord [12 ]
Meisner, Soren [13 ]
Messmann, Helmut [14 ]
Morino, Mario [15 ]
Neuhaus, Horst [16 ]
Piessevaux, Hubert [17 ]
Rugge, Massimo [18 ]
Saunders, Brian P. [19 ]
Robaszkiewicz, Michel [20 ]
Seewald, Stefan [21 ]
Kashin, Sergey [22 ]
Dumonceau, Jean-Marc [23 ]
Hassan, Cesare [24 ]
Deprez, Pierre H. [25 ]
机构
[1] Inst Portugues Oncol Francisco Gentil, Dept Gastroenterol, P-4200072 Porto, Portugal
[2] Hop Edouard Herriot, Dept Digest Dis, Lyon, France
[3] Ist Clin Humanitas, Dept Gastroenterol, Milan, Italy
[4] Klinikum Bayreuth, Inst Pathol, Bayreuth, Germany
[5] Natl Canc Inst, Dept Gastroenterol, Bari, Italy
[6] Osped Valduce, Gastroenterol Unit, Como, Italy
[7] Univ Clin Internal Med 1, Salzburg, Austria
[8] Queen Alexandra Hosp, Dept Gastroenterol, Portsmouth, Hants, England
[9] Pomeranian Med Univ, Szczecin, Poland
[10] Osped Sanremo, Dept Gastroenterol & Endoscopy, San Remo, Italy
[11] Erasmus MC, Rotterdam, Netherlands
[12] Med Univ Graz, Inst Pathol, Graz, Austria
[13] Bispebjerg Hosp, DK-2400 Copenhagen, Denmark
[14] Klinikum Augsburg, Dept Internal Med 3, Augsburg, Germany
[15] Univ Hosp Turin, Dept Surg, Turin, Italy
[16] Evangel Krankenhaus Dusseldorf, Dept Internal Med, Dusseldorf, Germany
[17] Catholic Univ Louvain, Clin Univ St Luc, B-1200 Brussels, Belgium
[18] Univ Padua, Dept Pathol, I-35100 Padua, Italy
[19] St Marks Hosp, Wolfson Unit Endoscopy, London EC1V 2PS, England
[20] Univ London Imperial Coll Sci Technol & Med, London, England
[21] Hop Cavale Blanche, Serv Hepatogastroenterol, Brest, France
[22] Klin Hirslanden, GastroZentrum, Zurich, Switzerland
[23] Yaroslavl Reg Canc Hosp, Endoscopy Dept, Yaroslavl, Russia
[24] Gedyt Endoscopy Ctr, Buenos Aires, DF, Argentina
[25] Nuovo Regina Margherita Hosp, Dept Gastroenterol, Rome, Italy
关键词
EARLY GASTRIC-CANCER; LYMPH-NODE METASTASIS; HIGH-GRADE DYSPLASIA; SQUAMOUS-CELL CARCINOMA; EARLY ESOPHAGEAL CANCER; LATERALLY SPREADING TUMORS; SINGLE-CENTER EXPERIENCE; LONG-TERM OUTCOMES; SPECIALIZED INTESTINAL METAPLASIA; EARLY COLORECTAL NEOPLASIA;
D O I
10.1055/s-0034-1392882
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
1 ESGE recommends endoscopic en bloc resection for superficial esophageal squamous cell cancers (SCCs), excluding those with obvious submucosal involvement (strong recommendation, moderate quality evidence). Endoscopic mucosal resection (EMR) may be considered in such lesions when they are smaller than 10mm if en bloc resection can be assured. However, ESGE recommends endoscopic submucosal dissection (ESD) as the first option, mainly to provide an en bloc resection with accurate pathology staging and to avoid missing important histological features (strong recommendation, moderate quality evidence). 2 ESGE recommends endoscopic resection with a curative intent for visible lesions in Barrett's esophagus (strong recommendation, moderate quality evidence). ESD has not been shown to be superior to EMR for excision of mucosal cancer, and for that reason EMR should be preferred. ESD may be considered in selected cases, such as lesions larger than 15mm, poorly lifting tumors, and lesions at risk for submucosal invasion (strong recommendation, moderate quality evidence). 3 ESGE recommends endoscopic resection for the treatment of gastric superficial neoplastic lesions that possess a very low risk of lymph node metastasis (strong recommendation, high quality evidence). EMR is an acceptable option for lesions smaller than 10-15mmwith a very low probability of advanced histology (Paris 0-IIa). However, ESGE recommends ESD as treatment of choice for most gastric superficial neoplastic lesions (strong recommendation, moderate quality evidence). 4 ESGE states that the majority of colonic and rectal superficial lesions can be effectively removed in a curative way by standard polypectomy and/or by EMR (strong recommendation, moderate quality evidence). ESD can be considered for removal of colonic and rectal lesions with high suspicion of limited submucosal invasion that is based on two main criteria of depressed morphology and irregular or nongranular surface pattern, particularly if the lesions are larger than 20 mm; or ESD can be considered for colorectal lesions that otherwise cannot be optimally and radically removed by snare-based techniques (strong recommendation, moderate quality evidence).
引用
收藏
页码:829 / 854
页数:26
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